It’s no secret that abortion opponents want the Trump administration to restrict access to abortion pills: Members of Congress, state officials and activist groups have all urged the Food and Drug Administration to make the medications harder to get — as suggested in Project 2025’s playbook. In the first eight months of Trump’s second term, though, it was unclear whether the White House would take action or let federal judges do the dirty work through separate lawsuits.
But last week, news broke that Health and Human Services Secretary Robert F. Kennedy Jr. and FDA Commissioner Martin Makary reportedly informed Republican-led states that the FDA is conducting a review of the “safety and efficacy” of the drug mifepristone, which is typically used alongside a second medication, misoprostol, to end an early pregnancy.
That this news came out the same week as the administration’s acetaminophen debacle is clarifying — because the two issues are more connected than one might think.
The letter, dated Sept. 19, was in response to nearly two dozen Republican AGs who urged HHS in July to reimpose outdated regulations on the medication, like requiring multiple in-person appointments to obtain the medication, and only allowing it to be used through seven weeks of pregnancy rather than the current 10. In their response, Kennedy and Makary said the review will be “thoroughly investigating the circumstances under which mifepristone can be safely dispensed.” They wrote that “HHS — through the FDA — is conducting its own review of the evidence” to determine if changes are necessary.
There is no legitimate need for such a review, when more than 100 studies have already found that mifepristone is a safe way to end a pregnancy. But anti-abortion forces view the pills — which can be sent in the mail to patients in all 50 states — as an existential threat to their state-level bans, and to their larger goal of ending abortion nationwide. Project 2025, for example, called to end telemedicine prescriptions of the drug, if not pull it from the market entirely.
Nearly two-thirds of all abortions in the U.S. in 2023 were done with pills, and 1 in 4 U.S. abortions by the end of 2024 were done with pills via telehealth. Half of those medication abortions — or 1 in 8 abortions — were prescribed by providers operating in the eight states with so-called “shield laws.” These laws allow abortion providers to treat telehealth patients across state lines and protect them from civil or criminal actions initiated by other states. For many patients residing in states where abortion is now illegal, this remote option is the only feasible way to have abortions at all after the Supreme Court overturned Roe v. Wade. You can imagine, then, why abortion opponents want, first and foremost, to end telehealth prescriptions. Reinstating any other restrictions on pills would be icing on the cake for them.
It is notable that Kennedy and Makary’s letter cites a dubious “study” from the far-right Ethics and Public Policy Center, which was involved in the drafting of Project 2025. The EPPC’s analysis, which was not peer-reviewed, appears to dramatically overstate what it characterizes as “serious adverse effects” associated with the pill. The paper is “seriously flawed,” Stella Dantas, former president of the American College of Obstetricians and Gynecologists, told the AFP news agency, and “manipulates data to drive a myth that medication abortion isn’t safe.”
For example, the EPPC’s analysis claims that needing an in-clinic procedure to complete an abortion is a complication, when patients are counseled in advance that the pills’ failure rate is about 3% to 4%. It also counts ectopic pregnancies, when an embryo implants somewhere other than the uterine lining, as a serious complication, even though mifepristone does not cause ectopics, nor is it used to treat them.
Kennedy and Makary’s treatment of the EPPC study as legitimate medical evidence is akin to them announcing that the Trump administration is going to do to mifepristone what they did to acetaminophen: use cherry-picked data to achieve a predetermined outcome.
During a Monday press conference, President Donald Trump told pregnant women not to take Tylenol, the brand name of acetaminophen, claiming that it was linked to autism. With Kennedy among the Trump staffers in attendance, the president added that pregnant people should only take it if they have a high fever and “can’t tough it out.”
White House officials, including Makary, cited one study published last month that found women who reported taking acetaminophen during pregnancy were slightly more likely to have a child later diagnosed with autism. But many experts say the study wasn’t rigorously conducted, and that the underlying reasons why someone might take the medication, such as fever or pain, could be what affects the growing fetus. Acetaminophen is one of the few pain relievers recommended for women to take during pregnancy.
Nevertheless, Makary’s FDA said Monday that it “initiated the process for a label change … to reflect evidence suggesting that the use of acetaminophen by pregnant women may be associated with an increased risk of neurological conditions such as autism and ADHD in children.”
Medical groups like the Society for Maternal-Fetal Medicine (SMFM) continue to advise that pregnant patients use the drug for pain and fever. “Untreated fever, particularly in the first trimester, increases the risk of miscarriage, birth defects, and premature birth, and untreated pain can lead to maternal depression, anxiety, and high blood pressure,” the organization said in a statement earlier this month. ACOG added, “The conditions people use acetaminophen to treat during pregnancy are far more dangerous than any theoretical risks and can create severe morbidity and mortality for the pregnant person and the fetus.”
This administration has already shown that it will ignore scientific evidence to advance its own narratives, which makes the letter on the abortion drug mifepristone all the more chilling. And the interplay of these two issues could be devastating.
If the FDA makes abortion pills less accessible, more people will be pregnant against their will. They will be navigating the administration’s new “recommendations” for acetaminophen use in pregnancy, which could result in worse health outcomes for them and their babies. People with unintended pregnancies are less likely to get timely prenatal care and could miss out on conversations with doctors about the risks of untreated fevers and pain. For instance, ACOG noted that headaches are an early sign of pre-eclampsia, a serious blood pressure condition that can cause life-threatening complications. Headaches could also be a sign of dangerous blood clots.
Women shouldn’t “tough it out” — they need public health agencies and medical providers that take their pain seriously. And they should of course be able to make their own decisions about their pregnancies. This anti-science administration is going to harm pregnant women and babies, and it simply doesn’t care.
This article was originally published on MSNBC.com
